Leveraging primary care data to understand military veteran health in England: Feasibility study and matched-control comparative health profile

Background Evidence on the health needs of UK veterans accessing primary care is limited. Electronic health records (EHRs) offer an opportunity to address this evidence gap if veterans are correctly identified. This study validated the identification of veterans in the Clinical Practice Research Datalink (CPRD) and assessed its feasibility for examining their health compared with non-veterans. Methods We conducted a matched cohort study in CPRD, the largest primary care database in the UK, identifying veterans using military-related codes in patients’ EHRs. Each veteran was matched to one or two non-veterans on age, gender, practice and index date. Validation was undertaken through general practitioner confirmation of veteran status. We compared demographics, risk factors and health conditions using descriptive statistics. Poisson regressions assessed the association between veteran status and various physical and mental health conditions. Results 122,484 veterans and 244,573 matched non-veterans were identified. Ninety-five percent were captured using definite military terms, and validation showed substantial agreement with GP records. Veterans had higher prevalence across all conditions. The largest differences were observed for PTSD (adjusted prevalence ratio [aPR] 16.43, 95% CI 14.89–18.13), followed by Alzheimer’s disease (aPR 2.74, 95% CI 2.56–2.92), alcohol use disorder (aPR 2.23, 95% CI 2.09–2.39), hearing loss (aPR 2.09, 95% CI 2.02–2.15), and osteoarthritis (aPR 1.98, 95% CI 1.93–2.30). Prevalence was also higher among veterans for COPD (aPR 1.83, 95% CI 1.77–1.89), depression (aPR 1.83, 95% CI 1.79–1.87), prostate cancer (aPR 1.83, 95% CI 1.73–1.94), coronary heart disease (aPR 1.78, 95% CI 1.72–1.84), lower back pain (aPR 1.73, 95% CI 1.70–1.77), and myocardial infarction (aPR 1.65, 95% CI 1.56–1.75). Differences for anxiety and breast cancer were modest. Conclusions This study establishes the foundation for UK veterans’ health research using primary care data, enabling the use of CPRD to monitor health trends, identify needs, and evaluate interventions at scale. The validated, transferable method supports future research to improve health outcomes among UK veterans.